The present invention, for the sake of simplicity is discussed herein particularly as it relates to therapeutic activity following maxillo-facial surgery. It should be borne in mind however, that the inventor has many other uses within the scope thereof.
Especially in the case of maxillo-facial surgery, the mandible is typically immobilized with respect to the maxilla such as by means of various types of retainer devices such as retainer wires, retainer bands, etc. to stabilize the bone structure and to maintain dentition in desired occlusion during healing of the bone structure. After an extended period of mandibular immobilization the temporalis and masseter muscles tend to become atrophied and the temporo-mandibular joint may become somewhat seized or restricted. In order to restore the mandible to its normal range of movement about the temporo- mandibular joint, the patient is normally required to undergo a therapeutic procedure where the mandible is forcibly operated by means of a mobilizer and/or by means of any of a number of other therapeutic devices. It has been found helpful in the restoration of the temporalis and masseter muscles to the normal range of extension and contraction, to apply heat or cold to the region of the temporalis and masseter muscles as well as to the region of the temporo-mandibular joint, either before, during or after mandible mobilizing therapy. It is considered desirable, therefore, to provide a suitable means for selective application of heat or cold to these specific facial areas and to provide the heat and cold in such manner so as not to interfere with normal therapeutic activities.
Many medical and dental patients are known to encounter difficulty, pain sensation, etc. with respect to the temporo- mandibular joint and in some cases, the sinuses in the region of the TMJ. It is well known that the selective application of heat and/or cold in accordance with a desired therapeutic sequence can yield effective relief to the patient. In most cases heat or cold is applied by positioning a heat pack or ice pack in engaging relation with the region of the TMJ or the temporalis and masseter muscles. This is typically a cumbersome and time consuming procedure especially because the patient must hold the apparatus in place or must tape it to the body. It is desirable therefore, to provide therapeutic means for selective application of heat or cold to the cranial region of the temporalis and masseter muscles and TMJ through means that is supported entirely by the head of the patient and which therefore permits the patient to accomplish other tasks and to conduct other activities while undergoing heat/cold therapy.
The cranial anatomy in the region of the temporalis and masseter muscles and the region of the TMJ, though being fairly smooth, nevertheless provides projections and depressions. To adequately deliver therapeutic heat or cold to this region, it is for the most part appropriate to maintain sufficient forcible contact of the heat pack or ice pack with the target region of the cranial anatomy such that efficient heat transfer is made. It is desirable, therefore, to provide a therapeutic system for application of heat or cold which is capable of establishing efficient heat transferring, surface-to-surface relation with the target region of the cranial anatomy while at the same time requiring application of only minimal mechanical force against facial surfaces to thereby permit the patient to undergo efficient heat or cold therapy in such manner as to be free from the pain or discomfort that might be caused if the mechanical force that is necessary if heat transfer were localized. It is desirable, for the comfort of the user to engage the target-region with a low pressure force per unit area and yet achieve efficient heat transfer to the target region.
In some cases physical therapy by means of therapeutic application of heat or cold may require periodic application of heat followed by periodic application of cold during any given therapy procedure. It is desirable, therefore, to provide a suitable means for accomplishing simple, quick and efficient change of the therapeutic application of heat or cold to a target region of the cranial anatomy simply by switching the heat or cold applicators or refilling internal compartments that provide for heat or cold transfer to the target region. It is further desirable to provide means for therapeutic application of heat or cold to the cranial anatomy that permits virtually any patient, regardless of the patient's manual dexterity, to simply and efficiently conduct heat or cold therapy themselves, without necessitating close attention by a therapist and perhaps while the patient is conducting self therapy in the home or at a location away from the attention of any medical personnel. For example, for the relief of sinus pain or for thermal restorative therapy following maxillo-facial surgery self-therapy may be conducted while riding in any sort of conveyance, while at home or work, even while sleeping. Thermal therapy of this nature is not limited to the cranial region of the human anatomy. For example, thermal therapy of the shoulders, ankles, knees, elbows, etc. may also be treated through use of the present invention.
From the standpoint of heat/cold application to the cranial anatomy areas of frequent pain, especially following maxillofacial surgery, include the temporalis muscles just above and slightly forward of the ear and the sinuses in the region of the temporalis muscles. The masseter muscles located below and slightly forward of the ear are also sources of pain as are the tempor-mandibular joints at the bottom and slightly forward of the ears. Since all of these "target regions" of the cranial anatomy benefit from heat/cold therapy, it is desirable to provide thermal cells to be supported by a suitable support, such as a headband or support band and which has sufficient adjustability for selective positioning of the thermal cells at widely spaced target regions such as the temporalis and masseter muscles. Additionally, it is desirable to provide thermal cells of appropriate configuration for adequate coverage of selected target regions and to provide for substantially omnidirectional movement of the thermal cells relative to the support structure, i.e. rotation, pivoting etc. to enable the thermal cells to achieve intimate heat/cold transmitting relation with the target region.
The use of "water bottles" for application of heat or cold to the human body is quite well known. Water bottles are typically completely flexible devices, except for the filling opening thereof. Their use for therapeutic purposes has certain shortcomings which are considered as follows: If a hot water bottle is filled to the point that it is completely distended then it can be applied to a body surface in any position such as from the top down, from the side or from the bottom up. Being rigidly filled and distended however, hot water bottles will only conform intimately to a body surface by application of substantial mechanical pressure; enough pressure to cause elastic deformation of the flexible container. This significant mechanical pressure however can cause discomfort to the user and can result in interruption of or interference with capillary blood flow in the body tissues adjacent the contacted body surface. Interruption or interference with the capillary blood flow significantly retards the capability of the heat transfer to penetrate beneath the skin to other tissues for which therapy may be desired. It is desirable therefore to maintain intimate contact with a selected body surface for efficient heat transfer thereto and to ensure that application of mechanical force is maintained sufficiently low that efficient capillary blood flow can transport heat or cold to the selected tissues for therapeutic purposes.
If a conventional hot water bottle is filled to less than its capacity then it may be applied only downwardly against the target surface so as to utilize the assistance of gravity to establish intimate contact of its heat transferring surface with the body surface. When applied downwardly in this manner the hot water bottle, being only partly filled, will conform intimately to the body surface by bending and without stretching. No mechanical pressure is required in addition to the gravitational force that maintains the heat transferring surface in intimate surface conforming contact with the body surface.
If an attempt is made to apply a hot water bottle filled to less than capacity sideways against a body surface gravity will cause the fluid within the hot water bottle to descend to the lower portion of the container, i.e. slumping downwardly. This causes the vertical, body contacting surface to establish poor conformity with the body surface and to establish only partial contact of the heat transferring fluid contained therein to the heat transferring surface. Obviously the result is poor heat transferring capability and difficulty of controlling application of heat or cold to a selected target region. Any attempt to push on the side of the flexible hot water bottle container with a retainer of small dimension merely accomplishes displacement of the thermal medium laterally and causes the force application of the small retainer to come into nearly direct contact with the skin tissue. Thus hot water bottles are only functionally efficient if they are applied to the body surface by means of a force that encompasses significant surface area, such as pushing against the hot water bottle with the entire hand of the user. Similarly, when a hot water bottle filled less than capacity is applied to the body tissue from an underside position, the deflection is similar but more pronounced. Thus when a small force applying device is used to hold a hot water bottle against the skin surface from the underside only the central portion of the hot water bottle will engage the skin and peripheral portions will descend downwardly due to gravitational force so that the only area of the hot water bottle in contact with the skin surface is quite small in comparison with its overall dimension. It is desirable therefore to provide a thermal cell construction having a compliant thermal transfer surface of large dimension and yet having the capability of engagement with a target anatomical surface with low internal pressure and low applied mechanical pressure or force in such a manner that the heat transferring surface conforms intimately with the contacted body surface and establishes efficient heat transferring contact therewith while maintaining a low force per unit area contact with the target surface.